Ablation of right atrial tachycardias through general mapping of multipolar catheter and careful mapping of ablative catheter through swartz sheath

Objective To investigate the methods of mapping and ablation for right atrial tachycardia. Methods 12 patients with right atrial tachycardias were confirmed as intra-atrial reentry tachycardias by routine electrophysiologic examination. Multipolar mapping catheter was curved and rotated in the right atrium to map the different atrial walls for finding the site of relative early atrial electrogram preceded the P wave in the surface electrocardiogram during tachycardia. Then ablative catheter was used to map carefully near this site through Swartz sheath to locate the earliest site of atrial activation where radiofrequency energy was delivered. The energy was titrated from 15W to 25W. Results Ablation was successful in all twelve patients without any complication and recurrence druing a follow-up perriod of (26±14)months. The sites of successful ablation located near coronary sinus ostium in 5 patients, near the His bundle in 2 patients, in the middle of atrial septum in 3 patients, in the high-lateral wall of right atrium in 2 patients. The local atrial electrograme preceded the onset of the P wave by (42±12) ms at the successful ablation site. The atrial tachycardias were terminated by using 15W of power for less than 5s. Successful ablation in the 12 patients required 2～6 radiofrequcency energy applications and (38±16) min fluoroscopy time. Conclusion It is simple and effective that radiofrequency ablation of right atrial tachycardia was guided by general mapping of multipolar catheter and careful mapping of ablative catheter through Swartz sheath to locate the site of earliest atrial activation.